Holly Powell Kennedy, a certified nurse-midwife, studied “exemplary” midwives and their patients to try and learn what is unique and exemplary about the midwifery model of care. That is, what is different about the way that midwives provide care from the way that physicians provide care? The critical difference that emerged from Holly’s study was the midwives’ art of doing “nothing” well; that is, being there with the woman, being vigilant to assure that things were going well, but not intervening or using technology unless it was necessary. One woman summed it up by saying, “A large part of her providing the kind of care we wanted is what she didn’t do… she didn’t rush anything … she said to me your body knows what to do so just let it do it.” Some of the qualities that were strongly identified by women with midwifery care were belief in the normalcy of birth, exceptional clinical skills and judgment, and commitment to the health of women and families. The following terms were also strongly identified by women with the midwives who cared for them: calm, patient, confident, decisive, intelligent, mature, persistent, honest, compassionate, trustworthy, flexible, understanding and supportive, warm, nonjudgmental, gentle, nurturing, not focused on self, realistic, reassuring and soothing, possessing a generous and loving spirit, possessing a sense of homor, and being personable.
Why is it important to try to identify what it is that midwives do differently and do well? Midwifery care has been shown to be safe, effective, and satisfying for women, but there has been little research on why this is so, that is, on the process of midwifery care. If women are to continue to have access to midwifery care in the future, midwives must be able to describe our philosophy and process of care and link these attributes to our outcomes. Holly Kennedy’s landmark study is a significant contribution to this effort. (Kennedy HP (2000). A model of exemplary midwifery practice: results of a Delphi study. J Midwifery & Women’s Health, Volume 45, No. 1, pp. 4-19.)
You may need some ammunition to convince your family or your friends that you are doing the right thing by deciding to have a midwife attend your birth. You will also want to find out about other professionals who work with midwives and enhance the experiences of pregnancy, labor and birth, and early parenthood. The following resources should be helpful to you.
The official source of information about certified nurse-midwives and certified midwives is the American College of Nurse-Midwives. The Midwives Alliance of North America has information about direct-entry midwives. Other sources of information about direct-entry midwives are Citizens for Midwifery (CfM), a consumer organization allied with MANA, a resource for midwives, birth professionals, parents, and others to find information about birth and parenting alternatives. Check the glossary and the history pages to find out more about the official midwifery organizations and types of midwives.
The Childbirth Connection has written an excellent pamphlet which you can download on their website entitled “Statement of the Rights of Childbearing Women”. It will give you some points to consider before or during your search for a midwife or other provider. Remember, first of all, you have the right to ask a prospective provider about her/his philosophy and practice! The best time to ask is before you make a decision.
The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Their mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs. Their website will get you started thinking about your choices for childbirth. The information in this document is based on research evidence about the kinds of care that result in optimal outcomes for mother and baby. The CIMS website also provides more information about evidence-based maternity care for providers.
Midwifery care is supported by research. The Cochrane Collaboration is a systematic review of the research evidence about the effects of care given to women during pregnancy and childbirth. It classifies elements of care as effective, promising, not proven either way, or not worth using. The database is available in printed format as well as in a regularly updated electronic format. Now twenty years old, the Cochrane Database of Systematic Reviews continues to validate the midwifery model of care. For data on specific aspects of care, go to the Cochrane Pregnancy and Childbirth Group Abstracts.